Cardiology for Lawyers (Medico-Legal Practitioner Series) by Roger Blackwood

By Roger Blackwood

Cardiology contains 20 in step with cent of all acute drugs. All medical professionals, in no matter what speciality, are considering it and it has turn into a space of litigation which has dramatically elevated within the final 5 years. many varieties of difficulties have arisen. may still the health professional diagnose angina whilst the sufferer first offers with chest ache? may still the sufferer be warned of the risks of cardiac catheterisation? Is thrombolsis secure to offer to a sufferer who has had a stroke? those are the various difficulties that have ended in significant situations and it's very tough for the attorney to appreciate those difficulties with no an sufficient history of clinical cardiology. the rise in felony circumstances concerning cardiology is such that any attorney dealing in clinical negligence will necessarily come upon this sort of challenge a number of occasions a yr. Roger blackwood, MA BM BCh FRCP, is advisor heart specialist at Wexham Park and Heatherwood Hospitals' belief, Slough, and Honorary advisor at Hammersmith medical institution, London.

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In approximately 15% of occasions medical treatment does not settle unstable angina. If pains become recurrent the patient will undoubtedly require angiography. Thus, during admission for unstable angina transfer to a teaching or tertiary hospital may be necessary. Angiography will delineate the lesion, often a 90% narrowing, which is most likely to be causing the unstable angina. After angiography, a decision is made as to whether to proceed to angioplasty or coronary artery bypass grafting. The success of these procedures is similar to stable angina although results may be modified by the extent of left ventricular damage occurring prior to the current episode.

It consists of exercises, education and psychological help. Reduction of risk factors is very important, eg stopping smoking, a low fat diet and weight loss. Cardiac rehabilitation will continue for several months after discharge. FOLLOW-UP AFTER DISCHARGE It is usual for patients to be followed up about six weeks after discharge, especially for an exercise test. The exercise test is extremely helpful in assessing prognosis after which patients will need further investigation. The DVLA recommends that patients resume driving (normal licence) at eight weeks post-infarction.

The problems of beta-blockers are their side effects. The catch phrase for them is ‘weariness and dreariness’. In addition they can provoke asthma in a susceptible patient and, although some beta-blockers are said to be cardio-selective, all of them must be totally precluded in patients who have an asthmatic tendency. Because beta-blockers vaso-constrict the blood vessels of the skin, patients may complain of cold hands and feet. This is seldom worrying although very inconvenient, but can cause problems to patients with restricted blood flow to their legs and may worsen intermittent claudication.

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